Covid: Doctors call for Covid Plan B to start in England

By Hazel Shearing & Joseph Lee
BBC News

Woman in face mask at outside marketImage source, Getty Images

An “unacceptable” level of Covid cases means ministers should trigger their Plan B for the pandemic in England, doctors say.

The British Medical Association accused the government of being “wilfully negligent” for not reimposing Covid rules such as mandatory face masks.

Daily UK infections have been above 40,000 for eight days in a row.

Health Minister Edward Argar said the NHS is not under “unsustainable pressure” to justify restrictions.

He told BBC Breakfast there were about 95,000 beds in NHS hospitals, with 7,000 occupied by Covid patients and 6,000 currently empty.

“We know how those numbers can rise swiftly, which is why we’re looking at that day by day, hour by hour. But at the moment we do have the ability to manage,” he said.

The health secretary has warned daily cases could soon rise to 100,000 but is rejecting fresh restrictions right now.

Speaking at a Downing Street news conference on Wednesday, Sajid Javid said that “at this point” the government would not bring in its Plan B measures – which include compulsory face coverings and Covid passports for entry to nightclubs and large events, as well recommending working from home

But he warned insufficient vaccine uptake would make restrictions in England more likely.

Over the last seven days, the number of Covid patients admitted has risen by 11% and the number of deaths has increased by 21%, compared to the previous week, although they remain far below their peak in January.

Under the government’s plan for tackling Covid in England over the winter, the strategy currently in operation is Plan A.

It involves offering booster jabs to about 30 million people and offering a single vaccine dose to healthy 12 to 15-year-olds, as well as encouraging ventilation for indoor gatherings, hand-washing and face masks in crowded places.

Restrictions included in Plan B will only be reintroduced if the NHS comes under “unsustainable pressure”.

Dr Chaand Nagpaul, the BMA’s chairman, said doctors “can categorically say that time is now”.

He stressed that case numbers were comparable to March, when England was in lockdown, and were “unheard of in similar European nations”.

“It is therefore incredibly concerning that [Mr Javid] is not willing to take immediate action to save lives and to protect the NHS,” he said.

Dr Nagpaul said the government had “taken its foot off the brake, giving the impression that the pandemic is behind us and that life has returned to normal”.

He said: “It is wilfully negligent of the Westminster government not to be taking any further action to reduce the spread of infection”, adding that compulsory face coverings, physical distancing and ventilation requirements in “high-risk settings” were “the norm in many other nations”.

His comments echoed the demands of health leaders from the NHS Confederation this week.

And they came as Prof Sir Mark Walport, the government’s former chief scientific adviser, said “the current measures are probably not holding things” when it came to the spread of the virus.

“Am I worried? Yes. It’s very, very delicately poised,” he told BBC Newsnight.

“Winter is coming, flu is probably coming. It’s not a good place to be.”

Chart showing that the number of daily cases are rising. Updated 20 October
Chart showing the number of daily Covid deaths is rising. Updated 20 October

In his Downing Street briefing, Mr Javid urged people to get booster vaccines and wear face coverings in crowded places with people they did not know.

Otherwise, he said, “it’s going to hit us all” – “and it would of course make it more likely we’re going to have more restrictions”.

However, No 10 said there were no plans for another lockdown in England.

Implementing Plan B would bring England effectively in line with restrictions still in place in Scotland, Wales and Northern Ireland.

In Scotland, face coverings are still compulsory on public transport and in places such as shops; people are asked to continue working from home where possible; and people attending nightlife venues and large events must prove their vaccination status.

Similar rules apply in Wales’ current winter planning scenario, dubbed Covid Stable.

As well as an existing requirement for face masks indoors and a focus on working from home, Northern Ireland has plans to introduce Covid passports and mandatory social distancing if hospital pressures become unsustainable.

The UK reported another 49,139 cases on Wednesday, and a further 179 deaths within 28 days of a positive test.

Around 14% of people in the UK aged 12 and over remain unvaccinated.

Shadow health secretary Jonathan Ashworth accused Mr Javid of complacency, telling the BBC: “The simple truth is that the so-called wall of defence we’ve built up with vaccination is now crumbling.”

He said it was disappointing the health secretary did not give details on “how he is going to grip this and drive up the vaccinations we need”.

The Antivirals Taskforce has secured 480,000 courses of molnupiravir, which trials found cuts the risk of hospital admission or death by about half, as well as 250,000 courses of PF-07321332/ritonavir, which is currently undergoing clinical trials.

If approved by the UK’s medicines regulator, the Department of Health said thousands of patients would be able to access the treatments this winter.


FDA greenlights mix-and-match booster doses

The Food and Drug Administration (FDA) amended its emergency use authorization for all COVID-19 vaccines on Wednesday to allow for mix-and-match boosters for patients who initially received a different vaccine.

The federal agency also authorized booster shots for Americans who received the Moderna and Johnson & Johnson inoculations. The FDA had previously authorized boosters for the Pfizer vaccine.

The decision will allow recipients of all three vaccines to get booster doses from other companies, if and when the Centers for Disease Control and Prevention (CDC) issues an official recommendation, which could come as early as Thursday.

“The available data suggest waning immunity in some populations who are fully vaccinated. The availability of these authorized boosters is important for continued protection against COVID-19 disease,” acting FDA Commissioner Janet Woodcock said in a statement.

“As the pandemic continues to impact the country, science has shown that vaccination continues to be the safest and most effective way to prevent COVID-19, including the most serious consequences of the disease, such as hospitalization and death,” she added.

The FDA’s move supporting mixed vaccine doses follows a preprint study from the National Institutes of Health that found that mixing and matching any of the three vaccines authorized in the U.S. was safe and effective.

Allowing mixed boosters is likely to smooth the messaging and logistics of the booster rollout by allowing pharmacists and doctors the flexibility to administer available shots to patients.

Peter Marks, director of the FDA’s vaccines division, in a statement said the agency included the use of mix-and-match boosters to address a “public health need.”

Moderna was granted authorization for a half dose of its vaccine as a booster, for people older than 65, adults with underlying conditions and those with jobs or living situations that put them at risk of contracting the virus at least six months after the initial series.

Johnson & Johnson’s extra dose would be available at least two months after vaccination for everyone 18 years and older.

The broader eligibility is a reflection that the vaccine offers a lower level of protection than the shots from Moderna and Pfizer.

During a media briefing late Wednesday, Marks and Woodcock acknowledged that the different eligibility criteria for boosters can be confusing for the general public, but the agency is developing charts other material to help providers better understand.

“We have tried to keep this as uniform as possible but it was not possible to have it totally uniform, because we’re dealing with different vaccines,” Woodcock said.

“Although it is not simple … it’s not utterly, hopelessly complex, and so hopefully with some clear illustrations, it will be somewhat more accessible what’s going on here,” Marks added.

The majority of fully vaccinated people, at almost 105 million, received the Pfizer-BioNTech doses, according to CDC data.

Almost 70 million Americans are fully vaccinated with the Moderna series, while slightly more than 15 million received a Johnson & Johnson shot. That number reflects a later arrival on the market and a troubled rollout that included manufacturing problems and a ten day pause to investigate rare but serious blood clots.

CDC Director Rochelle Walensky signed off on booster doses of the Pfizer-BioNTech vaccine late last month, which gave nearly 60 million Americans eligibility.

The CDC’s Advisory Committee on Immunization Practices is likely to provide more detailed guidance during its meeting Thursday, and experts hope the agency emphasizes that people who need a booster should try to receive the same vaccine as their primary dose.

Woodcock said during the briefing she anticipates people will not seek out different doses.

“We would expect many people will continue to get the same series that they had already received,” Woodcock said.

The FDA is also reportedly considering lowering the age of eligibility for booster shots to people aged 40 and older, without any underlying health conditions.

During the briefing, Marks indicated such a move was likely to happen but did not give a timeframe.

“There is evidence to suggest potentially that lowering the age of those eligible for boosters may make sense in the future, something we’re looking at closely,” Marks said.

“The nice thing about our [emergency use authorization] authority is that we are relatively nimble. It is something that can happen as soon as we see and feel that we need to take that action, and the exact age that we take will be based on what we see in terms of the emerging situation.”


US: Plans to Vax kids 5 to 11

The White House on Wednesday unveiled its plans to vaccinate children between the ages of 5 and 11 years old, pending authorization by the Food and Drug Administration (FDA) in the coming weeks.

The Biden administration said it has purchased enough vaccines to give shots to all of the country’s 28 million children ages 5 to 11 years old, and have been working with state and local leaders to be ready to distribute the vaccines once they are authorized.

The distribution plan will rely on more than 25,000 pediatricians’ office, community health centers, schools and pharmacies to put parents and children at ease, rather than the mass vaccination sites used in the initial rollout for adults.

The administration said it is also launching a partnership with the Children’s Hospital Association to work with more than 100 children’s hospital systems across the country to set up vaccination sites in November and through the end of the calendar year.

“Parents know and trust children’s hospitals to be there for their children’s medical needs, and these vaccination efforts will be no different. Pediatricians, pediatric specialists, nurses and team members will administer the vaccine to kids in trusted, family-friendly settings that serve kids every day,” according to the fact sheet.

The details come ahead of an Oct. 26 meeting of an FDA advisory panel to discuss authorization for pediatric vaccines. If the panel recommends authorization, an FDA ruling could come in the days after, which would then clear a path for the Centers for Disease Control and Prevention (CDC) to make recommendations on a pediatric dose in early November.

White House COVID-19 response coordinator Jeff Zients said the administration was not trying to get ahead of public health agencies by announcing a distribution plan before any vaccine has been authorized.

“I think the best practice here is to plan ahead so that we can hit the ground running at the time that CDC and FDA make their decision,” Zients said at a briefing Wednesday.

Surgeon General Vivek Murthy echoed the need for planning ahead, and said the preparation needs to be in advance of the authorization.

“All these conversations we’re having with community organizations, the logistics that have to be set up with doctors offices and pharmacies. It takes time, and that’s one of the reasons why this planning has to start so early, it can’t wait until a final decision is rendered,” Murthy said.

“Although that final decision is clearly up to the FDA and the CDC,” he added.

According to the White House, the vaccine will have packaging available in smaller configurations that will make it easier for physicians’ offices and other smaller, community-based providers to use.

The vaccine will be stored in 10-dose vials, and packed in cartons of 10 vials each. To keep it from spoiling, the vaccine can be stored for up to 10 weeks at standard refrigeration temperatures and up to six months at ultracold temperatures, according to an administration fact sheet.

The vaccine will also come with all the ancillary supplies that providers need to serve kids, including smaller needles.

The plan will rely heavily on states, tribes and territories to help implement a smooth rollout.

To that end, the Federal Emergency Management Agency (FEMA) is providing full funding to states to support vaccination operations and outreach — including setting up sites, procuring equipment and supplies to store and administer the vaccine.

FEMA will also provide transportation to and from vaccination sites and will help with public communication like public service announcements and translation services.


NYC extends vaccine mandate to all public workers


© Getty Images

New York City on Wednesday announced that it is expanding its vaccine mandate to all public employees and it will also end the option of testing weekly instead of getting the vaccine.

The city says that the mandate will affect 160,500 city workers, as they will be required to have one dose of the vaccine by Oct. 29. The only workers excluded are some uniformed corrections officers that will have a deadline of Dec. 1.

City employees who provide proof of vaccination by the Oct. 29 deadline will get a $500 bonus in their paychecks, while those who don’t submit documentation will be placed on unpaid leave until they do.

“There is no greater privilege than serving the people of New York City and that privilege comes with a responsibility to keep yourself and your community safe,” New York City Mayor Bill de Blasio (D) said.

“We have led the way against COVID-19 — from fighting for the right to vaccinate frontline workers, to providing nation-leading incentives, to creating the Key to NYC mandate. As we continue our recovery for all of us, city workers have been a daily inspiration. Now is the time for them to show their city the path out of this pandemic once and for all,” he added.